Healthcare Provider Details

I. General information

NPI: 1922620962
Provider Name (Legal Business Name): RIKKI NICOLE LONGMORE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NSA SOUDA BAY MOUZOURAS AKROTIRIOUS
CHANIA CRETE
73100
GR

IV. Provider business mailing address

PSC 814 BOX 19
FPO AE
09266-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-266-1597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102206731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: